IMB Health Notes – w/c 04 Nov 2019

The IMB reports published during the week commencing 04 November 2019 were from these 3 establishments:

  • HMP The Verne
  • HMP Bullingdon
  • HMP/YOI Bronzefield

IMB evidence comes from observations made on rota visits, scrutiny of records and data, attendance at various meetings, informal contact with staff and prisoners, prisoners’ applications and monitoring of areas of concern.

Here are some of the more interesting points contained within those reports, pertaining to health and wellbeing:

IMB Report – HMP The Verne

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • The Board stresses that this report covers the first 12 months of operation of what is a new prison and therefore considered a ‘work in progress’.
  • Extensive alterations have been made to facilitate disabled residents and a system of helpers (“buddies”) instituted for those requiring personal assistance. 60% of residents claim no disability whilst 10% of residents, the highest proportion of those declaring a disability, state they suffer from depression/mental illness. The number of residents over the age of 50 (53%) may help to explain the remaining high percentages of those declaring a disability: diabetic (5%); mobility (7%); visual impairment (4%); hearing loss (6%); heart disease (4%).
  • Not all residents are assessed by a nurse in reception on first night, due to them arriving too late in the day. They are offered screening for blood-borne viruses; about 10% opt out of this screening.
  • There have been challenges in all areas with shortage of staff and equipment failure, but these are being addressed. An agency nurse is covering mental health as it has not been possible to recruit a permanent mental health nurse lead.
  • DNAs rates are considered a problem at around 10% over all clinics, with efforts made to remind residents each day of their appointments but there seems no pattern to the underlying reasons for the DNAs. Access to the main health centre is difficult for wheelchairs, and therefore require rear door access.
  • The Integrated Substance Misuse Service (ISMS) team consists of one full time member and one part time. They run clinics, group sessions and one to one counselling. They currently see about 10% of residents.
  • Pharmacy provision is provided by a pharmacist and a pharmacy technician, with a second post being advertised. The pharmacy opened in July enabling a new system for collection of 28-day in possession medication; this makes collection of medicine much quicker and easier and has been well received.
  • Some residents are being trained to act as buddies/resident support assistants (RSA) for the more vulnerable residents. There is clear interest in the scheme and it seems to be working well.
  • Dorset wing has been adapted to cater for residents with mobility problems and special needs. 6 residents are wheelchair users. Wheelchair training is required for buddies and prison officers. More than 50 residents (mostly on Dorset wing) are subject to personal evacuation and emergency procedure (PEEP) in view of their reduced mobility. Each dormitory in Dorset wing has an evacuation orderly.
  • There were 4 healthcare applications to the IMB in what is the first full reporting year since re-opening.

Full IMB Report – HMP The Verne

IMB Report – HMP Bullingdon

Reporting period – 01 Jul 2018 to 30 Jun 2019.

  • As of 31 May 2019, Bullingdon had 274 uniformed staff: prison officers, senior officers and custodial managers. On that date, 78 of these officers were in their probationary year. There were 65 officers who had between one and two years of experience, and 131 officers (including senior officers and custodial managers) who had two or more years of experience. New officers have spoken of the good support and guidance that they have received from more experienced staff.
  • On average, 300 new prisoners entered the prison each month; this is between a quarter and a third of the total monthly population,
  • There were 225 prisoner-on-prisoner assaults for the reporting year, which is an increase on the 184 reported the previous year.
  • There were 141 assaults on staff for the same period, which is also an increase on the 126 reported the previous year.
  • Reported incidents of self-harm have increased by 6%, from 529 last year to 580 this year. There were 944 ACCT documents opened, often as a consequence, but also to rising levels of perceptions of being “at risk” and also some risk aversion.
  • There were 7 deaths in custody during the reporting year, which included the deaths of 2 men shortly after release, which are still recorded as deaths in custody. The previous year recorded 3 deaths in custody, and 2 the year prior to that.
  • There are continuing difficulties in recruiting permanent healthcare staff, although vacancies are mitigated by the use of a number of long-serving agency staff.
  • Healthcare complaints have decreased, reflecting an improvement in this service. The Board has had concerns about the effectiveness and transparency of the healthcare complaints procedure, and welcomes the introduction in June 2019 of a much more user-friendly complaints form.
  • The majority of healthcare-related complaints that the Board receives concern medication issues. Some prescription drugs that are available in the community are “not permitted” in prison. Approximately 50% of arriving prisoners are opiate dependent.
  • The Board is aware of high DNA rates for various medical services in the prison. Anecdotal evidence suggests that there are a number of reasons for this – examples are delays in issuing appointment slips, and clashes with times when prisoners have visitors, or prisoners may not wish to attend medication reviews in case their dosage is reduced. The prison has decided to work with healthcare staff to analyse the data, to determine why prisoners are missing appointments, and what steps can be taken to improve communication or to remove any other barriers that it reasonably can that have an impact on prisoners attending healthcare appointments.
  • Healthcare applications to the IMB decreased to 112 from 138 when compared to the previous reporting year.

Full IMB Report – HMP Bullingdon

IMB Report – HMP & YOI Bronzefield

Reporting period – 01 Aug 2018 to 31 Jul 2019.

  • The incidence of self-harm is high, increasing from a monthly average of 91 incidents in 2017/18 to 141 in the current reporting year. Some of this can be attributed to a few prolific self-harmers, but the monthly average number of self- harmers has also increased from 28 in 2017/18 to 33 in the current reporting year.
  • All but 61 of approximately 440 staff have now been trained in the updated (2018) HMPPS suicide and self-harm training package. All new operational staff undergo the training as part of their induction.
  • 517 ACCT plans were opened in the current reporting year, compared with 578 in 2017/18.
  • Self-harm ‘triggers’ for all prisoners on ACCT documents are now recorded on a common computer drive, so that staff have immediate access to them. The central record is then used to notify relevant staff when a trigger event is about to occur for an individual prisoner – for example, a court case or traumatic anniversary.
  • There has been one death in custody during the reporting period.
  • HMP/YOI Bronzefield has a 24-hour inpatient healthcare unit, which is one of only two across the female estate. Most prisoners are there for mental health conditions rather than physical illness. The unit has been at, or close to, capacity throughout the reporting period.
  • The Board considers the inpatients unit to be generally well run, with an enthusiastic, positive manager. The staff do an exceptional job in looking after prisoners, many of whom have complex mental healthcare issues.
  • The Board has observed that healthcare beds are sometimes used for operational rather than healthcare reasons, to manage complex prisoners who cannot be managed on the houseblocks or when the SCU is full.
  • There has been a severe shortage of nurses throughout the reporting year, which has had an impact on the provision of healthcare. Daily triage clinics on the houseblocks are frequently cancelled, cut short or postponed. New receptions often have to wait a considerable time before seeing a nurse. Bronzefield has gone to great lengths to recruit but there is a national shortage of nurses, and it has proved difficult. In June 2019, there were 15 vacancies for primary care nurses from a complement of 24, and 4 for recovery worker nurses, out of a team of 6.
  • The number of prisoners with mobility problems has increased in the past year, compounded by only one fully adapted and 3 partly adapted cells for disabled prisoners. Up to 18 prisoners have used a wheelchair over the reporting period, and many with walking aids.
  • All prisoners have equal access to the healthcare services. Waiting times for the GPs, dentists and opticians are consistent with those in the community.
  • The number of missed GP, triage and dental appointments is high. Around 20% of total appointments are not attended, compared with a national average in the community of about 5% missed GP appointments.
  • Some 95% of prisoners are on medication. Of these, 31% are prescribed both in-possession (IP) and dispensed medication, 10% are on non-IP medication only and 59% are prescribed IP-only medication.
  • On discharge, prisoners are given only 48 hours of prescription medication, which poses a clear issue for those who are not registered with a GP, often because they are released with no fixed abode.
  • In June 2019, the recovery workers’ team comprised 6 recovery workers and 5 peer recovery workers, who provide one-to-one, group, induction and in-cell support. There is a dedicated Substance Misuse GP who has been highly commended to the Board by prisoners. On average, 40% of the population of the prison is supported by the Substance Misuse team.
  • During the reporting year, 25 prisoners were transferred to secure inpatient mental health facilities, to which only 9 of those cases were transferred within the target of 14 days from the second (external) medical assessment.
  • Over this reporting period, the Board has observed increases of the number of prisoners residing on the healthcare unit with severe and enduring mental health problems. A number of these prisoners have required 3 prison custody officers to unlock them, which in turn has a negative impact on the regime for other prisoners. There have been 15 reported incidents of dirty protests on the healthcare unit during the reporting year.
  • Healthcare applications to the IMB decreased to 111 from 113 when compared to the previous reporting year.

Full IMB Report – HMP & YOI Bronzefield

Thanks to Ahmet Arslan for making this photo available freely on Unsplash